Reduced sleep quality in healthy girls at risk for depression

Modeling longitudinal relationships between sleep disturbances and depressed mood in postpartum: A cross-lagged panel design

BACKGROUND

This short communication explores the interrelationships between depressed mood and sleep disturbances in one-year postpartum period.

METHODS

Utilizing data from the Interaction of Gene and Environment of Depression during PostPartum Cohort (IGEDEPP) involving 3310 French postpartum women, we employed a cross-lagged panel model (CLPM) to analyze the relationships between these two symptoms, across three time points (immediate postpartum [<1 week after delivery], early postpartum [<2 months after delivery], and late postpartum [2 months to 1 years after delivery]).

RESULTS

Depressed mood significantly influences sleep disturbances in late postpartum (β = 0.096, z-value = 7.4; p < 0.001) but not in early postpartum (p-value = 0.9). We found no cross-lagged influence of sleep disturbances on depressed mood in early (p = 0.066) or in late postpartum (p = 0.060). Moreover, depressed mood and sleep disturbances in immediate postpartum are predictive of similar symptoms in the two other postpartum periods (between each of the three periods, p = 0.006 and p < 0.001 for depressed mood, and p = 0.039 and p < 0.001 for sleep disturbances), thus demonstrating the stability of these symptoms over time.

LIMITATIONS

Although conducted with a prospectively assessed cohort, this study faces limitations due to potential methodological biases.

CONCLUSIONS

This study is a pioneering analysis of mutual causal interactions between depressed mood and sleep disturbances in the postpartum period, highlighting the need for vigilant monitoring, early detection, prevention of worsen outcomes and intervention on these symptoms.

Effects of Blast-and Impact-Related Concussion on Persistent Sleep Problems

OBJECTIVE

Examine whether concussion mechanism of injury (high-level blast [HLB] vs impact) affects the likelihood of persistent sleep problems in a post-deployment military population.

SETTING

Post-Deployment Health Assessment and Re-Assessment survey records completed upon return from deployment and approximately 6 months later.

PARTICIPANTS

Active duty enlisted US Marines who completed both assessments (N = 64 464).

DESIGN

This retrospective cohort study investigated US Marines deployed between 2008 and 2012. Logistic regression was used to examine persistent sleep problems 6 months after return from deployment.

MAIN MEASURES

Self-reported sleep problems at reassessment were investigated as the outcome. Predictors included HLB-induced concussions (mbTBI vs none), impact-induced concussions (miTBI vs none), occupational risk of low-level blast, probable posttraumatic stress disorder (PTSD), depression, alcohol misuse, sleep problems upon deployment return, and relevant interactions, adjusting for sex and pay grade.

RESULTS

With the exception of sex, all main effects in the model were associated with greater likelihood of reporting persistent sleep problems at reassessment. Sleep problems at return from deployment showed the strongest associations with likelihood of reporting sleep problems at reassessment, followed by mbTBI. The latter was exacerbated by PTSD and depression.

CONCLUSION

mbTBI (vs miTBI) may be more strongly associated with persistent sleep issues that warrant additional monitoring and treatment, particularly among those with probable PTSD and/or depression.

Sleep disruption and premolar absence, NHANES, 2017-2020: A cross-sectional study

OBJECTIVE

Orthodontic treatment often involves four first premolar extractions. There is concern that the retraction of the anterior teeth due to extraction of first premolars may constrict tongue space and will reduce oral cavity and oropharynx space. Constricted airways are often associated with sleep disordered breathing (SDB) and sleep disruption. The aim of this study was to determine if there is an association of SDB factors with the absence of first premolars.

METHODS

A cross-sectional study was conducted using National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 data on participants, aged 18-65 years (n = 4742). Variables of interest included self-reports of SDB (symptoms of disrupted sleep such as snoring, snorting, daytime sleepiness, and inappropriate number of hours of sleep). Data for the presence/absence of first premolars were gathered from the oral examination section of NHANES. An assumption was made that absence of four first premolars in dentate participants indicated extractions for orthodontic treatment. Data analyses were conducted with Rao Scott chi squared test.

RESULTS

There were no significant associations of SDB and symptoms of disrupted sleep associated with the absence of four first premolars in dentate participants.

CONCLUSION

Concerns of the impact of first premolar extractions on SDB were not supported with this study.

Familial risk for depression is associated with reduced physical activity in young adults: evidence from a wrist-worn actigraphy study

Depression is characterized by reduced physical activity and sleep-wake cycle disturbances, often considered important features of the disease. While a few studies have suggested that self-reported reduced physical activity and sleep-wake cycle disturbances might both be linked to depression vulnerability, actigraphy-based measures in vulnerable samples remain largely unexplored. This study relied on actigraphy-based parameters to test whether these disturbances characterize depression vulnerability. Seven-day actigraphy data were collected from 20 (13 female) university students with a high vulnerability to depression, which was determined by the presence of a family history of the condition but no current symptoms, and 32 (21 female) controls with neither a family history of depression nor current depressive symptoms. Daily physical activity, namely gross motor activity, was quantified as average daily acceleration and time spent engaging in moderate-vigorous physical activity (MVPA). The sleep-wake cycle and circadian rhythms were assessed as total sleep duration per night (in hours), sleep within sleep period time (in hours), sleep efficiency (%), and relative amplitude (i.e., the difference between the activity during the day and the night, which reflects circadian rhythms amplitude). Results showed that individuals with a familial risk for depression exhibited reduced daily acceleration and time spent in MVPA relative to the control group, particularly on the weekend during their free time away from scheduled activities. On the other hand, the two groups were comparable in terms of sleep estimates. Taken together, reduced physical activity, but not sleep-wake disturbances, seem to be associated with vulnerability to depression and might be a viable target for identification and prevention efforts.

Demographic, lifestyle, social, and psychological factors associated with worry-related sleep problems among school-going adolescents in Timor-Leste

OBJECTIVE

Adolescent sleep problems are a worldwide public health issue. The present study examines factors associated with worry-related sleep problems among school-going adolescents. The country of interest is Timor-Leste, a low-income country, where studies pertaining to adolescent sleep problems are lacking.

DESIGN AND MEASURES

Data were analysed from the Global School-Based Student Health Survey Timor-Leste (n = 3455). An ordered probit model was used to assess the effects of demographic, lifestyle, social, and psychological factors on different levels of worry-related sleep problems (i.e., no, mild and severe sleep problems).

RESULTS

School-going adolescents were more likely to face mild or severe worry-related sleep problems if they were older, passive smokers, alcohol drinkers and moderately active. School-going adolescents who sometimes or always went hungry were more likely to experience worry-related sleep problems than those who did not. Involvement in physical fights, being bullied, and loneliness were positively associated with the probability of having modest or severe worry-related sleep problems.

CONCLUSION

Age, exposure to second-hand smoke, alcohol consumption, physical activity, going hungry, physical fights, being bullied and loneliness are the important determining factors of adolescent worry-related sleep problems. Policymakers should pay special attention to these factors when formulating intervention measures.

The Effect of Concussion Mechanism of Injury on Sleep Problems in Active Duty Service Members Following Deployment

INTRODUCTION

Sleep disruption is pervasive in the military and is generally exacerbated during deployment, partially due to increases in operational tempo and exposure to stressors and/or trauma. In particular, sleep disruption is a commonly reported symptom following deployment-related traumatic brain injury (TBI), though less is known about the prevalence of sleep disturbance as a function of whether the TBI was induced by high-level blast (HLB) or direct impact to the head. TBI assessment, treatment, and prognosis are further complicated by comorbidity with posttraumatic stress disorder (PTSD), depression, and alcohol misuse. Here, we examine whether concussion mechanism of injury is associated with differences in the prevalence of self-reported sleep disturbance following deployment in a large sample of U.S. Marines while accounting for probable PTSD, depression, and alcohol misuse.

MATERIALS AND METHODS

This was a retrospective cohort study of active duty enlisted Marines with a probable concussion (N = 5757) who completed the Post-Deployment Health Assessment between 2008 and 2012. Probable concussion was defined as endorsement of a potentially concussive event with corresponding loss or alteration of consciousness. The presence of concussion-related sleep problems was assessed with a dichotomous item. Probable PTSD, depression, and alcohol misuse were assessed using the Primary Care PTSD Screen, the Patient Health Questionnaire-2, and the Alcohol Use Identification Test-Concise, respectively. Logistic regression models investigated the effects of mechanism of injury (HLB vs. impact), PTSD, depression, and alcohol misuse on the presence of sleep problems, adjusting for sex and pay grade. The study was approved by the Naval Health Research Center Institutional Review Board.

RESULTS

Approximately 41% of individuals with a probable deployment-related concussion reported sleep problems following the event; 79% of concussed individuals reporting both HLB and probable PTSD reported sleep problems. All main effects were significantly associated with sleep disturbance in adjusted models. PTSD showed the strongest association with sleep disturbance (adjusted odds ratio [AOR] = 2.84), followed by depression (AOR = 2.43), HLB exposure (AOR = 2.00), female sex (AOR = 1.63), alcohol misuse (AOR = 1.14), and pay grade (AOR = 1.10). A significant HLB × PTSD interaction emerged (AOR = 1.58), which suggests that sleep disturbance was elevated among those with both HLB-induced (vs. impact-induced) concussions and presence (vs. absence) of PTSD. No other significant interactions emerged.

CONCLUSION

To our knowledge, this is the first study to examine the prevalence of concussion-related sleep complaints following deployment as a function of the mechanism of injury in individuals with and without probable PTSD and depression. Individuals with HLB-induced concussion were twice as likely to report sleep problems as those with an impact-induced concussion. Future work should examine these effects longitudinally with validated measures that assess greater precision of exposure and outcome assessment (e.g., blast intensity and type of sleep disturbance).

A bibliometric analysis of insomnia in adolescent

Background

The negative effects of insomnia on adolescents' development, academic performance, and quality of life place a burden on families, schools, and society. As one of the most important research directions for insomnia, adolescent insomnia has significant research value, social value, and practical significance. Unfortunately, there is no bibliometric analysis in this field of study. This study aims to analyze published articles using bibliometrics, summarize the current research progress and hot topics in this field systematically and exhaustively, and predict the future direction and trend of research.

Methods

For this study, the Web of Science Core Collection (WoSCC) database was searched between 2002 and 2022 for publications related to adolescent insomnia. The R-bibliometrix, VOSViewer, and CiteSpace software were utilized for bibliometric analysis.

Results

This investigation included 2468 publications from 3102 institutions in 87 countries, led by China and the United States. This field of research has entered a period of rapid development since 2017. The journal with the most publications on adolescent insomnia is Sleep, which is also the most co-cited journal. American Journal of Psychology has the highest impact factor among the top 10 journals. These papers were written by 10605 authors; notably, Liu Xianchen emerged as the author with the highest frequency of publications, while Mary A. Carskadon was the most frequently co-cited author. Mental health and comorbid diseases were the main research directions in this field. "Depression," "anxiety," "mental health," "COVID-19," "stress," "quality of life," "heart rate variability," and "attention-deficit hyperactivity disorder" were hot spots and trends in this field at the current moment.

Conclusion

The research on adolescent insomnia has social value, research value, and research potential; its development is accelerating, and an increasing number of researchers are focusing on it. This study summarized and analyzed the development process, hot spots, and trends of adolescent insomnia research using bibliometric analysis, which identified the current hot topics in this field and predicted the development trend for the future.

Association Between Insufficient Sleep, Depressive Symptoms, and Suicidality Among Florida High School Students

INTRODUCTION

Emerging research suggests insufficient sleep can heighten the risk of poor mental health among adolescents. We examined the relationship between sleep, depressive symptoms, and suicidal thoughts and behaviors among Florida high school students.

METHODS

Data were from the 2021 Florida High School Youth Risk Behavior Survey, a statewide representative sample of students in grades 9 to 12. We estimated prevalence of 1 indicator of depressive symptoms - feeling sad or hopeless for 2 or more weeks - and 2 indicators of suicidality - having considered attempting suicide and making a suicide plan - by insufficient sleep status (<8 h of sleep on an average school night). Multivariate logistic regressions were used to calculate odds ratios measuring the association between insufficient sleep, poor mental health, and suicidality.

RESULTS

Compared with students reporting sufficient sleep, those with insufficient sleep were more likely to feel sad or hopeless (42.7% vs 28.1%), have considered suicide (19.1% vs 12.5%), or have made a suicide plan (14.8% vs 9.6%). In adjusted multivariate models, compared with students with sufficient sleep, students with insufficient sleep had higher odds of feeling sad or hopeless (adjusted odds ratio [AOR] = 1.83; 95% CI 1.54-2.17), and having made a plan about how they would attempt suicide (AOR = 1.32; 95% CI, 1.00-1.74), but did not have significantly higher odds of having seriously considered suicide.

CONCLUSION

Increased attention to sleep as a modifiable risk factor for mental health among adolescents is particularly important because of the many less modifiable factors that contribute to mental health difficulties in this population. Adolescent mental health programs should consider sleep an important factor in suicide prevention.

Monitoring sleep using smartphone data in a population of college students

Sleep is fundamental to all health, especially mental health. Monitoring sleep is thus critical to delivering effective healthcare. However, measuring sleep in a scalable way remains a clinical challenge because wearable sleep-monitoring devices are not affordable or accessible to the majority of the population. However, as consumer devices like smartphones become increasingly powerful and accessible in the United States, monitoring sleep using smartphone patterns offers a feasible and scalable alternative to wearable devices. In this study, we analyze the sleep behavior of 67 college students with elevated levels of stress over 28 days. While using the open-source mindLAMP smartphone app to complete daily and weekly sleep and mental health surveys, these participants also passively collected phone sensor data. We used these passive sensor data streams to estimate sleep duration. These sensor-based sleep duration estimates, when averaged for each participant, were correlated with self-reported sleep duration (r = 0.83). We later constructed a simple predictive model using both sensor-based sleep duration estimates and surveys as predictor variables. This model demonstrated the ability to predict survey-reported Pittsburgh Sleep Quality Index (PSQI) scores within 1 point. Overall, our results suggest that smartphone-derived sleep duration estimates offer practical results for estimating sleep duration and can also serve useful functions in the process of digital phenotyping.

Rethinking the risk for depression using the RDoC: A psychophysiological perspective

Considering that the classical categorical approach to mental disorders does not allow a clear identification of at-risk conditions, the dimensional approach provided by the Research Domain Criteria (RDoC) is useful in the exploration of vulnerability to psychopathology. In the RDoC era, psychophysiological models have an important role in the reconceptualization of mental disorders. Indeed, progress in the study of depression vulnerability has increasingly been informed by psychophysiological models. By adopting an RDoC lens, this narrative review focuses on how psychophysiological models can be used to advance our knowledge of the pathophysiological mechanisms underlying depression vulnerability. Findings from psychophysiological research that explored multiple RDoC domains in populations at-risk for depression are reviewed and discussed. Future directions for the application of psychophysiological research in reaching a more complete understanding of depression vulnerability and, ultimately, improving clinical utility, are presented.

Adverse childhood experiences affect the health of middle-aged and older people in China: The multiple mediating roles of sleep duration and life satisfaction

Background

Although a significant amount of literature has examined the association between childhood adversity and adverse health outcomes, which may be affected by sleep duration and life satisfaction. However, this relationship has not been researched in the Chinese population. This study aimed to assess the association between childhood adversity and health outcomes, with sleep duration and life satisfaction as mediators.

Methods

A total of 14,693 subjects aged 45 and over from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were included. Taking childhood adversity as the independent variable, the health level of middle-aged and older individuals as the dependent variable, and sleep time and satisfaction as the mediating factors, Mplus 8.0 software was used to establish a structural equation model (SEM) to analyze the link between childhood adversity and health level and to explore the mediating effect of target mediators between childhood adversity and health level.

Results

In this study, childhood adversity was positively associated with depression symptoms, activities of daily living (ADL), and the number of chronic diseases (r = 0.116, 0.026 and 0.050, respectively, P < 0.001). Associations between adverse childhood experiences (ACEs) and depressive symptoms, ADL, and number of chronic diseases were mediated by sleep duration and life satisfaction, respectively.

Conclusion

Adversity experienced in childhood can affect the health status of middle-aged and older people. By ensuring adequate sleep and improving life satisfaction, health outcomes can be improved, and the negative effects of childhood adversity can be reduced.

The Effects of Anthropomorphism, Message Framing, and Voice Type on Unhealthy Sleep Behavior in Young Users: The Mediating Role of Risk Perception

Insufficient sleep is a severe social public health problem that can adversely affect the physical and mental health of young people. This study examined risk perceptions for unhealthy sleep behaviors and intentions for healthy sleep behaviors under different combinations of anthropomorphism, message framing, and voice type in cartoons. We used a three-factor between-subject experiment of two (anthropomorphism: anthropomorphic vs. non-anthropomorphic) × two (message framing: positive frame vs. negative frame) × two (voice type: cartoon child voice vs. adult female voice) design. We examined the effects of different audiovisual combinations of cartoon attitude, risk perception, and behavioral intention and the mediating role of risk perception. The research results show that (1) the integration of anthropomorphic design elements can positively impact users’ attitudes toward cartoons; (2) when the interface information is presented in a negative frame, anthropomorphism can more positively influence users’ attitudes toward cartoons than non-anthropomorphism; and (3) anthropomorphism, message framing, and voice type in cartoons significantly interact with risk perception. In addition, risk perception mediates the influence of anthropomorphism, message framing, and voice type on behavioral intention.

Sleep and Mental Health Among Adolescents During the COVID-19 Pandemic

OBJECTIVE

This study aimed to investigate the association of sleep with mental health among Korean adolescents during the coronavirus disease (COVID-19) pandemic.

METHODS

Using data from the 16th Korea Youth Risk Behavior Web-Based Survey (2020) of 46,475 adolescents, we examined sleep duration and satisfaction and examined mental health for depressive symptoms, anxiety, and suicidal ideation. The data were analyzed using complex sample descriptive statistics and a multiple logistic regression model.

RESULTS

In 2020, the average sleep duration was 6.3 hours, and the sleep satisfaction rate was 30.8%. Depressive symptom and suicidal ideation rates were 24.2 and 10.3, respectively. These values are slightly better than those previously reported, before COVID-19. However, poor sleep was still associated with mental health. The likelihood of mental health problems was higher among those who slept for six hours or less than for those who slept for eight hours or more (p<0.05). Additionally, the results showed that the lower the sleep satisfaction, the higher the likelihood of mental health problems (p<0.05).

CONCLUSION

Even after the COVID-19 outbreak, poor sleep associated with mental health problems remained as high as before the outbreak of COVID-19.

Predictors of Sleep-Problem Trajectories Across Adolescence

Stress and sleep problems are significantly correlated in adolescents. Few longitudinal studies, however, have evaluated possible correlates and predictors of sleep problems at multiple points across adolescence. The current study examined the relation between stress and sleep problems across four years in a sample of adolescents who varied in risk for psychopathology. Participants included 223 adolescents (55% female) and 223 mothers (77% with a history of a mood disorder during their child's life). Youth were evaluated in grade 7 (M = 12.69 years, SD = 0.61) and again in grades 8, 9, and 11. Sleep problems were assessed as part of a clinical interview, and weekly stressful events were measured with the Life Events Interview for Adolescents. Multi-group latent growth curve analyses were conducted. Among youth whose mothers had a history of depression (high-risk), sleep problems significantly increased over time (p < .001). Second, among high-risk youth, at each time point, higher stress levels during the prior three months significantly predicted higher levels of sleep problems (p < .001). Finally, across the entire sample, at each time point a greater level of sleep problems predicted higher stress ratings a year later (p ≤ .001). Thus, stress was a significant predictor of sleep problems across multiple years of adolescence, particularly among offspring of mothers with a history of depression. Results highlight targets for preventive interventions for sleep problems in youth.

COVID-19 quarantine in adolescents with autoimmune rheumatic diseases: mental health issues and life conditions

Objectives

To assess mental health and life conditions in adolescents with autoimmune rheumatic diseases (ARDs) and healthy controls quarantined during COVID-19 pandemic.

Method

A cross-sectional study included 155 ARD adolescents and 105 healthy controls. Online survey included self-reported strengths and difficulties questionnaire (SDQ), and a semi-structured questionnaire with demographic data, daily home and school routine, physical activities, and COVID-19 information during the pandemic.

Results

Among patients, 56% had juvenile idiopathic arthritis (JIA), 29% juvenile systemic lupus erythematosus (JSLE), and 15% juvenile dermatomyositis (JDM). No differences were found regarding sex, ethnicity, and current age between ARD patients and controls (p > 0.05). Abnormal emotional SDQ (38% vs. 35%, p = 0.653) were similar in both groups. Logistic regression analyses in ARD patients demonstrated that female (OR = 2.4; 95%CI 1.0–6.0; p = 0.044) was associated with severe emotional SDQ dysfunction, whereas sleep problems were considered as a risk factor for both worse total SDQ (OR = 2.6; 95%CI 1.2–5.5; p = 0.009) and emotional SDQ scores (OR = 4.6; 95%CI 2.2–9.7; p < 0.001). Comparisons between ARD patients with and without current prednisone use showed higher median scores of peer problems in the first group [3 (0–10) vs. 2 (0–7), p = 0.049], whereas similar median and frequencies between JIA, JSLE, and JDM (p > 0.05).

Conclusions

Approximately one third of JIA, JSLE, and JDM patients presented abnormal total and emotional scores of SDQ during COVID-19 quarantine. Sleep problems were the main factor associated with emotional difficulties in these ARD adolescents. The knowledge of mental health issues rates in adolescents with ARD supports the development of prevention strategies, like sleep hygiene counseling, as well as the references of the affected patients to specialized mental health services, as necessary.

Key Points • One third of ARD patients presented mental health issues during COVID-19 quarantine • Sleep problems were associated with emotional difficulties. • It is necessary to warn pediatric rheumatologists about the importance of sleep hygiene counseling.

The relationship between sleep and depression and bipolar disorder in children and young people

BACKGROUND

Sleep difficulties are often reported in practice, and are part of the diagnostic criteria for depression and bipolar disorder.

AIMS

To inform the understanding of the relationship between sleep and both depression and bipolar disorder.

METHOD

We conducted a narrative literature review of affective disorders and sleep difficulties in children and young people.

RESULTS

Specific sleep disorders, such as parasomnias, narcolepsy and sleep-related movement disorders, are associated with depression, whereas insomnia, obstructive sleep apnoea and circadian rhythm disorders are associated with both depression and bipolar disorder in children and young people. Conversely, children and young people with depression can present with a number of sleep difficulties, and these are associated with higher depression severity and greater fatigue, suicidal ideation, physical complaints, pain and decreased concentration. Sleep disturbances among adolescents with bipolar disorder can affect the severity of depressive and manic symptoms, are a poor prognostic indicator and have been associated with social and academic impairment. Antidepressants and antipsychotics can directly affect sleep architecture, which clinicians need to be aware of. Non-pharmacological interventions for sleep problems could prevent and/or minimise the risk of relapse in affective disorders.

CONCLUSIONS

Sleep difficulties can occur before, during and after an episode of depression or bipolar disorder, and have a higher prevalence in affective disorders compared with the general population. A multi-modal approach would include the treatment of both the affective and specific sleep disorder. Further research is needed in this field to understand the impact of combined interventions on clinical outcomes.

Deficits in Emotion Regulation Partly Mediate the Relation Between Sleep Problems and Depressive Symptoms in Adolescent Inpatients With Depression

Sleep problems are a risk factor for the development of depressive disorders and influence the severity and treatment of depressive symptoms negatively. To enhance treatment for depression in young people, it is important to advance the understanding of the relationship between sleep problems and depressive symptoms. Since deficits in emotion regulation are discussed as possible underlying mechanisms, the present study investigated the mediating effect of maladaptive and adaptive strategies for emotion regulation on the association between sleep problems and depressive symptoms. Emotion regulation strategies, depression and sleep quality were assessed via self-report in a large clinical sample of 602 adolescents (age 13-18 years) who reported clinically relevant symptoms of depression. The questionnaires were assessed at admission for inpatient psychiatric treatment. Correlation and mediation analyses were performed. There was a significant partial mediation effect (β = 0.554, p < 0.001, R ² = 0.527), indicating that sleep problems influenced depressive symptoms via the decreased use of adaptive strategies and the increased use of maladaptive strategies. Additionally, a direct effect of sleep problems on depressive symptoms emerged (β = 0.251, p < 0.001, R ² = 0.364). This cross-sectional study provides first indications that additional treatment modules focusing on sleep and ER skills in prevention and treatment programs for adolescents would be important steps. Longitudinal studies are needed to substantiate these results.

The association between sleep pathology and depression: A cross-sectional study among adults in Greece

A cross-sectional population based study was conducted in order to evaluate the potential association of sleep characteristics with depression using self-reported questionnaires and taking into account several socio-demographic, lifestyle and health related characteristics. 957 participants aged between 19 and 86 years old were enrolled in our study. Depression symptoms were assessed using the Beck Depression Inventory. Participants self-reported their daily sleep habits and filled in the Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index and Berlin Questionnaire. Overall prevalence of depression was 28.4%. Depression symptoms were more prominent among minority groups. Subjects with depression reported shorter sleep duration and had reduced sleep efficiency. In patients with depression mean sleep duration was reduced by 23 min and mean sleep efficiency by 4%. Patients with depression were at higher risk of insomnia, poor sleep quality and obstructive sleep apnea, but not of excessive daytime sleepiness. Concerning insomnia subtypes, depression was associated with difficulties maintaining sleep and early morning awakening, but not problems initiating sleep. Sleep disturbances are highly prevalent in depression and our findings support early pharmacological or cognitive behavioral interventions in order to address this key depression-associated symptom. Only addressing problems initiating sleep might not be sufficient in depression.

Higher Rates of Sleep Disturbance Among Offspring of Parents With Recurrent Depression Compared to Offspring of Nondepressed Parents

OBJECTIVE

Youth who have a parent with recurrent depression are at high risk for mental health problems. There is a need to identify transdiagnostic and clinically actionable mechanisms that explain higher rates of psychopathology among high-risk youth. The present study sought to examine whether offspring of depressed parents exhibit greater parent- and self-reported sleep disturbance, shorter sleep duration, and later sleep midpoint compared to youth without any parental psychopathology.

METHOD

Participants included 82 youth, including 41 youth (ages 9-13; mean age = 11.07 years; 46% female) deemed to be at high-risk based on having a parent with a recurrent depression history, and 41 (mean age = 11.16 years; 49% female) at low-risk based on having parents without any history of psychopathology. Youth and their parents completed measures of youth sleep disturbance, and youth completed measures of sleep duration and midpoint using a daily sleep diary for 9 days.

RESULTS

Offspring of parents with depression exhibited more sleep disturbance (e.g., problematic nighttime behaviors and daytime sleepiness) than low-risk youth as reported by both parents and youth. For parent-reported sleep disturbance, there were also sex differences. High-risk girls had more sleep disturbance than high-risk boys or low-risk girls. There were no group differences for daily sleep duration and midpoint.

CONCLUSION

Sleep disturbance may be an important area for assessment among offspring of parents with depression. Our findings highlight one potential transdiagnostic risk factor that may emerge among high-risk youth, and sex-specific differences in sleep disturbance, which have implications for prevention and intervention.

An Exploratory Study on Sleep Procrastination: Bedtime vs. While-in-Bed Procrastination

Sleep Procrastination literature has focused on the behaviors individuals engage in before going to bed (Bedtime Procrastination) but not on the behaviors individuals engage in after going to bed (While-in-Bed Procrastination). The main goal of this study is to explore whether this While-in-Bed procrastination is a novel phenomenon that adds to the Sleep Procrastination literature. The study was conducted online with 400 high school students (M_age = 16.56; 139 males) recruited through personal contacts and social media. The Bedtime procrastination scale was adapted and validated for this sample, whereas the While-in-Bed Procrastination scale was developed for this study. Data show a low correlation (r = 0.158 **) between Bedtime and While-in-Bed Procrastination scales, suggesting that Sleep Procrastination may be composed of the two facets. Additionally, results showed that more Bedtime Procrastination was related to later waking time and later dinnertime hours, whereas more While-in-Bed Procrastination was linked to being male, later desired time to sleep, and earlier dinnertime hour. Findings indicate that solely assessing Bedtime Procrastination as representing the procrastination of Sleep is limited and overlooks a significant part of this behavior. This exploratory study adds a new perspective to the literature by stressing the role of While-in-Bed Procrastination, thus opening new research pathways.

Sleep Disorders in Adolescents

Chronic sleep deprivation is a common, treatable condition among adolescents. Growing literature supports a myriad consequences that impact overall health, behavior, mood, and academic performance in this vulnerable age group during a time when there are rapid changes in physical development and emotional regulation. This article reviews the epidemiology and health effects of sleep deprivation in adolescents as well as common disorders leading to sleep loss and evidence to support treatment. Although a variety of important sleep disorders may disrupt quality of sleep in adolescents, such as obstructive sleep apnea, restless leg syndrome, and narcolepsy, this article will focus on common disorders that affect the quantity of sleep, such as poor sleep hygiene, circadian rhythm disorders, and insomnia.

The relationship between sleep efficiency and clinical symptoms is mediated by brain function in major depressive disorder

BACKGROUND

Sleep disturbance is a common and key symptom that affects most of patients with major depressive disorder (MDD). However, neural substrates underlying sleep disturbance and their clinical relevance in depression remain unclear.

METHODS

Ninety-six MDD patients underwent resting-state functional MRI. Fractional amplitude of low-frequency fluctuation (fALFF) and resting-state functional connectivity (rsFC) were used to measure brain function. Overnight polysomnography was performed to objectively measure sleep efficiency (SE), which was used to classify patients into normal sleep efficiency (NSE) and low sleep efficiency (LSE) groups. Between-group differences in fALFF and rsFC were examined using two-sample t-tests. Moreover, correlation and mediation analyses were conducted to test for potential associations between SE, brain functional changes, and clinical variables.

RESULTS

LSE group showed decreased fALFF in right cuneus, thalamus, and middle temporal gyrus compared to NSE group. MDD patients with low SE also exhibited lower rsFC of right cuneus to right lateral temporal cortex, which was associated with more severe depression and anxiety symptoms. More importantly, mediation analyses revealed that the relationships between SE and severity of depression and anxiety symptoms were significantly mediated by the altered rsFC. In addition, these low SE-related brain functional alterations were not affected by antidepressant medication and were independent of structural changes.

LIMITATIONS

The lack of healthy controls because of "first-night effect".

CONCLUSION

These findings not only may expand existing knowledge about neuropathology of sleep disturbance in depression, but also may inform real-world clinical practice by improving depression and anxiety symptoms through sleep regulation.

Sleep mediates the association between adolescent screen time and depressive symptoms

OBJECTIVE

This study examined the associations between four types of screen-based activities and depressive symptoms among adolescents. We further investigated whether sleep characteristics (ie, insomnia symptoms and sleep duration) mediate these associations.

METHODS

Data come from 2865 U.S. adolescents (mean age = 15.53, SD = 0.73, 51.8% male) in the age 15 follow-up of the Fragile Families and Child Wellbeing Study. Adolescents completed surveys regarding sleep duration and insomnia symptoms, typical daily duration of four screen activities (social messaging, web surfing, TV/movie watching, and gaming), and depressive symptoms. We constructed a multiple mediation model to elucidate the associations between age 15 screen time, sleep and depressive symptoms, while adjusting for age 9 depressive symptoms.

RESULTS

Structural Equation Modeling analyses revealed that the association between screen time and depressive symptoms is partially or fully mediated by sleep. For social messaging, web surfing and TV/movie watching, the three sleep variables fully mediated the positive association between screen time and depressive symptoms. For gaming, the three sleep variables acted as partial mediators in the model, accounting for 38.5% of the association between gaming and depressive symptoms.

CONCLUSIONS

Our results highlight both screen-based activities and sleep behaviors as potential intervention targets to reduce depressive symptoms among adolescents.

The Global Problem of Insufficient Sleep and Its Serious Public Health Implications

Good sleep is necessary for good physical and mental health and a good quality of life. Insufficient sleep is a pervasive and prominent problem in the modern 24-h society. A considerable body of evidence suggests that insufficient sleep causes hosts of adverse medical and mental dysfunctions. An extensive literature search was done in all the major databases for “insufficient sleep” and “public health implications” in this review. Globally, insufficient sleep is prevalent across various age groups, considered to be a public health epidemic that is often unrecognized, under-reported, and that has rather high economic costs. This paper addresses a brief overview on insufficient sleep, causes, and consequences, and how it adds to the existing burden of diseases. Insufficient sleep leads to the derailment of body systems, leading to increased incidences of cardiovascular morbidity, increased chances of diabetes mellitus, obesity, derailment of cognitive functions, vehicular accidents, and increased accidents at workplaces. The increased usage of smart phones and electronic devices is worsening the epidemic. Adolescents with insufficient sleep are likely to be overweight and may suffer from depressive symptoms. The paper concludes by emphasizing sleep quality assessments as an important early risk indicator, thereby reducing the incidence of a wide spectrum of morbidities.

Sleep, Sleep Disorders, and Circadian Health following Mild Traumatic Brain Injury in Adults: Review and Research Agenda

A rapidly expanding scientific literature supports the frequent co-occurrence of sleep and circadian disturbances following mild traumatic brain injury (mTBI). Although many questions remain unanswered, the preponderance of evidence suggests that sleep and circadian disorders can result from mTBI. Among those with mTBI, sleep disturbances and clinical sleep and circadian disorders contribute to the morbidity and long-term sequelae across domains of functional outcomes and quality of life. Specifically, along with deterioration of neurocognitive performance, insufficient and disturbed sleep can precede, exacerbate, or perpetuate many of the other common sequelae of mTBI, including depression, post-traumatic stress disorder, and chronic pain. Further, sleep and mTBI share neurophysiologic and neuroanatomic mechanisms that likely bear directly on success of rehabilitation following mTBI. For these reasons, focus on disturbed sleep as a modifiable treatment target has high likelihood of improving outcomes in mTBI. Here, we review relevant literature and present a research agenda to 1) advance understanding of the reciprocal relationships between sleep and circadian factors and mTBI sequelae and 2) advance rapidly the development of sleep-related treatments in this population.

Sleep Disorders and Their Management in Children With Ehlers-Danlos Syndrome Referred to Sleep Clinics

STUDY OBJECTIVES

The nature of sleep disorders in children with Ehlers-Danlos syndrome (EDS) is unknown. We aimed to describe the type, the management, and the short-term outcome of sleep disorders in children with EDS referred to sleep clinics.

METHODS

This is a retrospective review of medical records and polysomnography tests of children with EDS younger than 18 years who were referred to the sleep clinic. Demographic information and medical history were collected, and polysomnography tests were reviewed. Questionnaires completed during previous clinic visits, including the Pediatrics Sleep Questionnaire (PSQ), Epworth Sleepiness Scale (ESS), and Pediatric Quality of Life Inventory (PedsQL), were also evaluated.

RESULTS

Sixty-five patients with EDS-hypermobility type were included. The mean age was 13.15 ± 3.9 years. There were 68% of patients who were female, and 91% of patients were Caucasian. The mean follow-up period was 1.14 ± 1.55 years. Common sleep diagnoses included insomnia (n = 14, 22%), obstructive sleep apnea (OSA) (n = 17, 26%), periodic limb movement disorder (PLMD) (n = 11, 17%), and hypersomnia (n = 10, 15%). In addition, 65% required pharmacologic treatment and 29% were referred to behavioral sleep medicine. For OSA, two patients required continuous positive airway pressure. A significant improvement was observed in the PSQ, ESS, and PedsQL scores during follow-up visits after treatment (n = 34; P = .0004, 0.03, and 0.01, respectively).

CONCLUSIONS

There is a high prevalence of sleep disorders, including OSA, insomnia, PLMD, and hypersomnia in children with EDS referred to sleep clinics. Specific management can improve quality of life and questionnaire scores of this patient population. Our study emphasizes the importance of screening for sleep disorders in children with EDS.

A process-oriented model linking adolescents' sleep hygiene and psychological functioning: the moderating role of school start times

OBJECTIVE

To examine a mediational model linking sleep hygiene to better mental health in adolescents via the mechanism of improved sleep quality, and to test the moderating role of school start times (SST) (before 8:30 AM vs. 8:30 AM or later) on that mediation model.

DESIGN

Cross-sectional.

SETTING

Online survey for high school students across the United States.

PARTICIPANTS

A total of 197 adolescents aged 14-17 years old (M_age = 15.6 years, SD = 1.8; 53% female) completed a baseline survey and 7-day sleep diaries; their parents (M_age = 47.7 years, SD = 5.5; 79% female) reported on family socioeconomic status and high SST.

MEASUREMENT

Adolescents reported on their sleep hygiene, circadian chronotype, daily levels of sleep quality and duration (morning diaries) and their depressive/anxiety symptoms (evening diaries) for 7 days.

RESULTS

A moderated-mediation model suggested that baseline sleep hygiene was directly associated with lower average daily depressive/anxiety symptoms across all students, but that association was marginally stronger in students with later SST (8:30 AM or later). A mediated path emerged only for students with earlier start times, suggesting that, for those students, baseline sleep hygiene was indirectly associated with lower average daily psychological symptoms by improving average daily sleep quality.

CONCLUSIONS

The current study is one of the first to demonstrate that SST might serve as a critical moderator in models of adolescent sleep and daily functioning. The findings provide additional evidence in the debate on how SST may affect adolescent health.

Sleep problems and injury risk among juveniles: A systematic review and meta-analysis of observational studies

Recent studies have reported inconsistent results regarding the association between sleep problems and injury risk among juveniles. Moreover, the extent of this risk remains largely unexplored. Thus, a systematic review and meta-analysis was conducted by our team to determine whether sleep problems increase the incidence of injuries among juveniles. PubMed, PsycINFO, Embase, and Cochrane Library databases were searched for relevant studies that explored the association between sleep problems and injury risk and have been published before July 2016. Multivariate adjusted odds ratio (OR) and associated 95% confidence intervals (CIs) were extracted and pooled using random-effects models. A total of 10 observational studies involving 73,418 participants were identified. Meta-analysis findings suggested that juveniles with sleep problems held a 1.64 times higher risk of injury than that of juveniles without sleep problems (OR: 1.64, 95% CI: 1.44–1.85). This relationship was also supported by subgroup analyses, which were based on different countries and study designs. The current evidence indicates that sleep problems are significantly associated with injury risk among juveniles. Sleep problems are highly important for young people; hence, sleep researchers and occupational physicians should focus on this aspect. Nevertheless, high-quality and adequately powered observational studies are still needed.

Associations among daytime sleepiness, depression and suicidal ideation in Korean adolescents

The aim of this study was to examine the effects of daytime sleepiness on depression and suicidal ideation in adolescent high-school students. A survey of 538 high school students aged 16-17 years attending two academic schools was conducted. The Epworth Sleepiness Scale (ESS), the Beck Depression Inventory and the Scale for Suicide Ideation were used to assess subjects' daytime sleepiness, depression and suicidal ideation. The mean score for daytime sleepiness was 8.52, which indicates a sleep deficit. Significant positive correlations were found between daytime sleepiness and depression, between daytime sleepiness and suicidal ideation and between depression and suicidal ideation. Gender and depression were significant predictors of suicidal ideation, accounting for 48% of the variance in this measure. Depression acts as a mediator of the relationship between daytime sleepiness and suicidal ideation. High school students in Korea generally have insufficient sleep time and feel sleepy during the day; insufficient sleep during adolescence may be associated with depression and suicidal ideation.

The association between maternal postnatal depressive symptoms and offspring sleep problems in adolescence

BACKGROUND

Sleep problems are associated with increased risk of physical and mental illness. Identifying risk factors is an important method of reducing public health impact. We examined the association between maternal postnatal depression (PND) and offspring adolescent sleep problems.

METHOD

The sample was derived from Avon Longitudinal Study of Parents and Children (ALSPAC) participants. A sample with complete data across all variables was used, with four outcome variables. A sensitivity analysis imputing for missing data was conducted (n = 9633).

RESULTS

PND was associated with increased risk of sleep problems in offspring at ages 16 and 18 years. The most robust effects were sleep problems at 18 years [adjusted odds ratio (OR) for a 1 s.d. increase in PND, 1.26, 95% confidence interval (CI) 1.15-1.39, p < 0.001] and waking more often (adjusted OR 1.14, 95% CI 1.05-1.25, p = 0.003). This remained after controlling for confounding variables including antenatal depression and early sleep problems in infancy.

CONCLUSIONS

PND is associated with adolescent offspring sleep problems. Maternal interventions should consider the child's increased risk. Early sleep screening and interventions could be introduced within this group.

Effect of Changes in Sleep Quantity and Quality on Depressive Symptoms Among Korean Children

This study aims to determine whether changes in sleep quantity and quality in childhood are associated with incidence of depressive symptoms. We used the three waves of the Korean Children & Youth Panel Survey (2011-2013). Statistical analysis using a generalized estimating equation model was performed. The 2,605 subjects analyzed included 1,453 students in 2012 and 1,152 students in 2013 without depressive symptoms in the prior year. We found that deteriorated or consistently poor sleep quality were important risk factors for depressive symptoms in children. We suggest that early detection and intervention of poor sleep quality in elementary school is required to reduce early onset depressive symptoms.

Prevalence and Correlates of Insufficient Sleep Syndrome in Japanese Young Adults: A Web-Based Cross-Sectional Study

STUDY OBJECTIVE

This study investigated the prevalence and risk factors of insufficient sleep syndrome (ISS), and factors associated with daytime dysfunction in the disorder in Japanese young adults.

METHODS

In this cross-sectional study, a web-based questionnaire survey was used to assess demographic variables, sleep habits and quality, depressive symptoms, and health-related quality of life (HRQOL) in 2,276 participants aged 20-25.

RESULTS

Eleven percent of participants were classified as having ISS. Multiple logistic regression analysis revealed that the presence of ISS was significantly associated with social status (student or full-time employee). The participants with ISS had significantly higher depression scores and lower mental component summary scores than healthy sleepers. In the participants with ISS, a delayed sleep-wake schedule was extracted as a factor associated with worse mental component summary.

CONCLUSIONS

Results indicate a relatively high proportion of Japanese young adults suffer from ISS, and that the condition is associated with a social status of student or full-time employee. Moreover, a delayed sleep-wake schedule may lead to further deterioration of mental HRQOL in ISS-affected persons.

Cortical thickness predicts the first onset of major depression in adolescence

Given the increasing prevalence of Major Depressive Disorder and recent advances in preventative treatments for this disorder, an important challenge in pediatric neuroimaging is the early identification of individuals at risk for depression. We examined whether machine learning can be used to predict the onset of depression at the individual level. Thirty-three never-disordered adolescents (10-15 years old) underwent structural MRI. Participants were followed for 5 years to monitor the emergence of clinically significant depressive symptoms. We used support vector machines (SVMs) to test whether baseline cortical thickness could reliably distinguish adolescents who develop depression from adolescents who remained free of any Axis I disorder. Accuracies from subsampled cross-validated classification were used to assess classifier performance. Baseline cortical thickness correctly predicted the future onset of depression with an overall accuracy of 70% (69% sensitivity, 70% specificity; p=0.021). Examination of SVM feature weights indicated that the right medial orbitofrontal, right precentral, left anterior cingulate, and bilateral insular cortex contributed most strongly to this classification. These findings indicate that cortical gray matter structure can predict the subsequent onset of depression. An important direction for future research is to elucidate mechanisms by which these anomalies in gray matter structure increase risk for developing this disorder.

Sleep Deprivation Is Associated with Bicycle Accidents and Slip and Fall Injuries in Korean Adolescents

Objective

This study sought to evaluate associations between sleep time and bicycle accidents, falls under various circumstances, and dental injuries in adolescents.

Methods

A total of 61,696 participants ranging from 12 to 18 years of age who completed the Korea Youth Risk Behavior Web-based Survey (KYRBWS) in 2013 were enrolled in this study. Bicycle riding accidents were analyzed for 17,232 bicycle-riding participants. Data were collected regarding the weekday sleep duration for the most recent 7 days, which was categorized as < 5.5 h, 5.5–6.5 h, 6.5–7.5 h, or ≥ 7.5 h per day, and the incidence of bicycle accidents, slips and falls under various circumstances, and dental injuries in the most recent 12 months. Adjusted odds ratios (aORs) were calculated among sleep groups for bicycle accidents, slips and falls, and dental injuries using simple and multiple logistic regression analyses with complex sampling.

Results

Bicycle riding accidents and slips and falls in classrooms, corridors, the ground, toilets, stairs, and other unspecified situations showed positive correlations with sleep deprivation. Comparisons of groups with ≥ 7.5 h sleep, < 5.5 h, 5.5–6.5 h sleep, and 6.5–7.5 h sleep revealed increased associations with slips and falls under various circumstances. In particular, the aORs were higher in the groups with less sleep (aOR of the 5.5 h group > the 5.5–6.5 h group > the 6.5–7.5 h group). There was no significant relationship between sleep deprivation and dental injury.

Conclusions

This study demonstrated that sleep deprivation among Korean adolescents was associated with bicycle accidents and falls at home and school. Thus, adequate sleep may be needed to prevent accidents and falls.

Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion

The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health.

Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion

The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health.

Biomarkers of intergenerational risk for depression: a review of mechanisms in longitudinal high-risk (LHR) studies

BACKGROUND

Longitudinal research is critical for understanding the biological mechanisms underlying the development of depression. Researchers recruit high-risk cohorts to understand how risk is transmitted from one generation to the next. Biological measurements have been incorporated into these longitudinal high-risk (LHR) studies in order to illuminate mechanistic pathways.

METHODS

To frame our review, we first present heritability estimates along the gene-by-environment continuum as a foundation. We then offer a Biomarkers of Intergenerational Risk for Depression (BIRD) model to describe the multiple hits individuals at risk receive and to allow for greater focus on the interactive effects of markers. BIRD allows for the known multifinality of pathways towards depression and considers the context (i.e., environment) in which these mechanisms emerge. Next, we review the extant LHR cohort studies that have assessed central nervous system (electroencephalography (EEG), neuroimaging), endocrine (hypothalamic-pituitary-adrenal axis (HPA)/cortisol), autonomic (startle, heart rate), genetic, sleep, and birth characteristics.

RESULTS

Results to date, in conjunction with the proposed model, point towards several pathways of discovery in understanding mechanisms, providing clear direction for future research examining potential endophenotypes.

LIMITATIONS

Our review is based on relatively narrow inclusion and exclusion criteria. As such, many interesting studies were excluded, but this weakness is offset by strengths such as the increased reliability of findings.

CONCLUSIONS

Blanket prevention programs are inefficient and plagued by low effect sizes due to low rates of actual conversion to disorder. The inclusion of biomarkers of risk may lead to enhanced program efficiency by targeting those at greatest risk.

Sleep disturbances in patients with major depressive disorder: incongruence between sleep log and actigraphy

OBJECTIVE

Depression has become a severe global health problem, and sleeping difficulties are typically associated with depression. The purpose of this study was to investigate the relationships among subjective sleep quality, objective sleep quality, and the sleep hygiene practices of hospitalized patients with major depressive disorder.

METHOD

Daily sleep logs and actigraphy were used to obtain subjective and objective sleep data. Thirty patients were recruited from a regional teaching hospital in Taipei and completed the Hamilton Rating Scale for Depression and the Sleep Hygiene Practice Scale.

RESULTS

Significant differences were found between subjective and objective sleep data in patients with major depressive disorder (MDD). For patients with more severe depression, subjective measurements obtained using sleep logs, such as total sleep time and sleep efficiency, were significantly lower than those obtained using actigraphy by controlling for demographics.

CONCLUSIONS

The results regarding the differences between subjective and objective sleep data can be a reference for care providers when comforting depression patients who complain of sleep disturbance.

Insufficient sleep in adolescents and young adults: an update on causes and consequences

Chronic sleep loss and associated sleepiness and daytime impairments in adolescence are a serious threat to the academic success, health, and safety of our nation's youth and an important public health issue. Understanding the extent and potential short- and long-term repercussions of sleep restriction, as well as the unhealthy sleep practices and environmental factors that contribute to sleep loss in adolescents, is key in setting public policies to mitigate these effects and in counseling patients and families in the clinical setting. This report reviews the current literature on sleep patterns in adolescents, factors contributing to chronic sleep loss (ie, electronic media use, caffeine consumption), and health-related consequences, such as depression, increased obesity risk, and higher rates of drowsy driving accidents. The report also discusses the potential role of later school start times as a means of reducing adolescent sleepiness.

Sleep and sadness: exploring the relation among sleep, cognitive control, and depressive symptoms in young adults

BACKGROUND

Sleep disturbance is a common feature of depression. However, recent work has found that individuals who are vulnerable to depression report poorer sleep quality compared to their low-risk counterparts, suggesting that sleep disturbance may precede depression. In addition, both sleep disturbance and depression are related to deficits in cognitive control processes. Thus we examined if poor sleep quality predicts subsequent increases in depressive symptoms and if levels of cognitive control mediated this relation.

METHODS

Thirty-five undergraduate students participated in two experimental sessions separated by 3 weeks. Participants wore an actigraph watch between sessions, which provided an objective measure of sleep patterns. We assessed self-reported sleep quality and depressive symptoms at both sessions. Last, individuals completed an exogenous cuing task, which measured ability to disengage attention from neutral and negative stimuli during the second session.

RESULTS

Using path analyses, we found that both greater self-reported sleep difficulty and more objective sleep stability measures significantly predicted greater difficulty disengaging attention (i.e., less cognitive control) from negative stimuli. Less cognitive control over negative stimuli in turn predicted increased depression symptoms at the second session. Exploratory associations among the circadian locomotor output cycles kaput gene, CLOCK, single nucleotide polymorphism (SNP), rs11932595, as well as sleep assessments and depressive symptoms also are presented.

CONCLUSIONS

These preliminary results suggest that sleep disruptions may contribute to increases in depressive symptoms via their impact on cognitive control. Further, variation in the CLOCK gene may be associated with sleep quality.

Predeployment Sleep Duration and Insomnia Symptoms as Risk Factors for New-Onset Mental Health Disorders Following Military Deployment

STUDY OBJECTIVES

To evaluate predeployment sleep duration and insomnia symptoms in relation to the development of mental health symptoms.

DESIGN

Longitudinal cohort study.

SETTING

The Millennium Cohort Study survey is administered via a secure website or US mail.

PARTICIPANTS

Data were from 15,204 participants who completed their first deployment between the submissions of 2 consecutive Millennium Cohort questionnaires (2001-2008).

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

Using self-reported data from the Millennium Cohort Study we evaluated the association of predeployment sleep duration and insomnia symptoms on the development of new-onset mental disorders among deployers. Multivariable logistic regression was used to estimate the odds of developing posttraumatic stress disorder (PTSD), depression, and anxiety, while adjusting for relevant covariates including combat-related trauma. The study outcomes were assessed using validated instruments, including the PTSD checklist-civilian version, and the PRIME-MD Patient Health Questionnaire. We identified 522 people with new-onset PTSD, 151 with anxiety, and 303 with depression following deployment. In adjusted models, combat-related trauma and predeployment insomnia symptoms were significantly associated with higher odds of developing posttraumatic stress disorder, depression, and anxiety postdeployment.

CONCLUSIONS

Sleep characteristics, especially insomnia symptoms, are related to the development of mental disorders following military deployments. Assessment of insomnia symptoms predeployment may help to better identify those at highest risk for subsequent adverse mental health outcomes.

CITATION

Gehrman P; Seelig AD; Jacobson IG; Boyko EJ; Hooper TI; Gackstetter GD; Ulmer CS; Smith TC; for the Millennium Cohort Study Team. Predeployment sleep duration and insomnia symptoms as risk factors for new-onset mental health disorders following military deployment. SLEEP 2013;36(7):1009-1018.